Lecture 21 - Carcinoma Of The Prostate Flashcards
What is PSA?
Prostate specific antigen
What is the most common cancer in. Men?
Prostate cancer
What is the normal age range of developing prostate cancer?
Over 50
What are the risk factors for prostate cancer?
Increased age
Family history (BRACA2 gene mutation)
Ethnicity (Black and Asian)
What does a BRACA2 gene mutation increase the risk of in women?
Breast cancer
What are the 2 main zones of the prostate?
Peripheral zone (posterior part)
Transitional zone (more central)
What part of the prostate does prostate cancer typically affect?
Peripheral zone (posterior part)
What zone of the prostate does BPH normally develop in?
Transitional zone
What does prostate cancer often metastasise to?
Bone (normally the spine causing back pain)
How does prostate cancer typically present?
UTI symptoms (urinary symptoms)
Raised PSA
Bone pain
Opportunistic finding from DRE
Why is elevated PSA not diagnostic for prostate cancer?
Other prostate issues cause raised PSA
What can cause raised PSA?
Prostate cancer
Infection
Prostatitis (inflammation)
Large prostate
Urinary retention
What is opportunistic prostate screening?
When a DRE is done and the prostate is enlarged do the PSA test
What is the Gleason classification of prostate cancer?
Describes how well differentiate the tumours are
Grade 1 = well differentiated
Grade 5 = anaplastic
How is prostate cancer diagnosed?
Digital rectal examination reveals hard and irregular prostate
US see prostatic mass
Inc PSA levels (but if low not indicative of not cancer)
Biopsy of prostate
Radiographs and bone scans
How can a bone scan be used to identify metastasis?
Osteoosclerotic lesions have an increaased uptake of the isotope so appear as hotspots on bone scan
How do you treat localised prostate cancer?
T1/T2 radical surgical resection (prostatectomy) or TURP
Local radiotherapy can be used if patient unfit for surgery
Surveillance (if tumour slow growing)
What are the side effects of treating localised prostate cancer via prostatectomy?
Urinary incontinence
Erectile dysfunction
Infertility
Why can prostatectomy lead to urinary incontinence?
Pudendal nerve damage
What side effects can radiotherapy cause treating localised prostate cancer?
Discomfort around radiotherapy site
Diarrhoea
Loss of pubic hair
Tiredness
Inflammation of bladder lining
erectile dysfunction
What is brachytherapy?
Type of radiotherapy where the radioactive sees are inserted into the prostate gland to give high dose radiation just tot he prostate to reduce side effects
How is advanced prostate cancer treated?
Hormonal manipulation since testosterone promotes tumour growth
Surgical castration
Medical castration
Palliative care
What enzyme catalyses the conversion of testosterone to its stronger form dihydrotestosterone?
5a reductase
What are some ways of medical castration?
LHRH agonists
GnRH agonists
What are the side effects of castration?
Reduction of testosterone causes:
-thinning of bones
-dec muscle mass
-inc breast size
-weight gain
—mood changes
-hot flashes
What is the prognosis for 5yr survival for T1 prostate cancer tumours?
What about if theres local or metastatic spread?
T1 = 75-90%
Local or metastatic = 30 - 45%
What is the median sulcus of the prostate?
Line between the 2 lobes of the prostate
How should a healthy prostate feel?
Soft with give
How does the prostate feel with BPH?
Firm + enlarged
How does a prostate carcinoma feel?
Cant feel distinct lobes
Lumps and bumps
What are some differential diagnoses:
65yr male
Hesitancy + nocturia
Weight loss
Lower back pain but no injury
BPH
Metastatic prostate cancer
Prostatitis
Urethral strictures
What does elevated PSA indicate?
Prostate issue
What are the signs of urinary obstruction?
Hesitancy
Haematuria
Cant pass urine
Flank or abdominal pain
How is T2 prostatic cancer treated?
Surgical removal of prostate
Radiotherapy
